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SIX BASIC PRINCIPLES OF MEDICAL ETHICS
Theme: “Social Contract in Health Care” SIX BASIC PRINCIPLES OF MEDICAL ETHICS By Brig[R]. Abrar Hussain Zaidi Consultant Surgeon HITEC-IMS - Taxila
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Innate Human Desire To see the doctors
as the most trusted and respected persons in the society
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Trust is indeed withering due to declination and deviation
Doctors world over are still ; Regarded very highly & trusted upon [shown by polls] But Trust is indeed withering due to declination and deviation from basic Medical Ethics
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TO DISCUSS MEDICAL ETHICS
A MORAL OBLIGATION TO DISCUSS MEDICAL ETHICS Responsibility of every teaching physician to train the budding physicians. Not only in the art of medicine, but also in handling the ethical dilemmas of medical practice. [Hadith]
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about human activities determine the acceptable human conduct
ETHICS Discipline of addressing and evaluating the social concerns about human activities that determine the acceptable human conduct
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Social Concerns & How should we conduct ourselves in society
ETHICS Social Concerns Normal Acceptable vs Abnormal Unacceptable & How should we conduct ourselves in society
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-Individual to community -Community to community
CONCERNS MAY BE ; -Individual to individual -Individual to community -Community to community e.g. Marriage and families, Business, Neighborhood, Prisoners, wars, Medical practice.
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all over the world. Regional & geographic differences may exist. But,
the basic human norms & values are same all over the world.
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MEDICAL ETHICS Discipline that: A- Guides The Doctors;
Relationships: Patients, Colleagues, Society Decision-making : in Patient Care B-Defines and Evaluates; Social Concerns In Medical Practice Benefits & Risks To Human Life Conduct Of Health Professionals Standards Of Behavior Of Professionals C- Make The Basis For Laws - Pertaining To Health Care
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How to determine what is ethical and what is not?
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Criteria The Fundamentals/Principles of Medical Ethics
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Principles/Criteria Make The Basis For
Guidance – Ethical/Acceptable practices Evaluation- Social conduct of health professionals Making laws-Basis of modern legal practice Guidance : individual & institutional
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EVOLUTION OF MEDICAL ETHICS
Medical ethics have evolved over centuries Greek th century BC Chinese ---2nd century BC. Indian Roman Islamic Code Of Medical Ethics Modern Era
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4th century BC. The Greek physician Hippocrates The Hippocratic Oath Eight Paragraphs Swearing The Oath: Pledge to; “Keep the patients from harm and injustice.” “Give support to fellow physicians.”
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10th century Adab al- Tabib (Ethics of a Physician) most extensive works on ethics by Ishaq ibn Ali Ruhawi Christian who embraced Islam. English translation by American Philosophical Society, Philadelphia Basis of modern day description of principles of Medical Ethics
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EVOLUTION OF MEDICAL ETHICS The Present Era
Regional /Country Regulating Bodies AMA NHS PMDC [ Pakistan] WHO WMA 1847 Code of Medical Ethics.
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EVOLUTION OF MEDICAL ETHICS THE PRESENT ERA
World Medical Association Description of “Standards of conduct” Oct 1948 –The Second General Assembly Oath of Geneva [IF WE REMEMBER] The Declaration of Helsinki Human Experimentation/Research
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SIX OF THE PRINCIPLES OF MEIDCAL ETHICS
1-Beneficence Act In The Best Interest Of Humanity. 2-Non-maleficence Do No Harm 3-Autonomy Patient’s Right To Refuse Or Choose [Consent] 4-Justice Treatment On The Merit Of Illness 5-Dignity Patient And Doctor Both To Be Respected 6-Confidentiality The ’ Trust’ / Not be Shared against the will The criteria: that make the foundation of our OATH AND on the basis of which Various bodies have developed the declarations and guidelines for their regional practices That guide in making the laws governing medical practice Some Basic principles that have evolved over centuries
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Foundation of; Doctors oath Social conduct of doctors
Present days legal medicine Van Guards of Care : Sentinel Projects and Beacons When we talk about the van Guards of care = then what's guides what’s right and what’s wrong These basic “Principles are the Beacons” that the individual stand on guard take the light from Weather you just Evaluate an individual Social Conduct in the professional environment, Evaluation of a Socio-Medical scenario OR you Make a law
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the benefit of the patient.
Ethical principles are primarily patient centered, for the benefit of the patient.
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SOCIO MEDICAL SITUATIONS
Reception / Communication Medical examination Wards Theatres Treatment options Consent Ventilatory support Cost Legal issues/courts Research Family planning Abortion Blood transfusion Organ Donations & transplant
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1-2-BENEFICENCE & NON-MALEFICENCE
Do only what is good and bring no harm.
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1-2-BENEFICENCE & NON-MALEFICENCE
Patient’s wellbeing Mental Physical Social Material
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1-2-BENEFICENCE & NON-MALEFICENCE
a-Think good The intention b-Talk /say good----The words c-Do good The acts & d- Do no bad Mental/Physical/Social/Material
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[the first step in the right direction]
1-2-BENEFICENCE & NON-MALEFICENCE a- Think good Al Aamal O Bin Niiat [the first step in the right direction] May Allah help me in doing all good and bring no harm to anyone by: My Thoughts My Words My Acts
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Expression - Representative of your thoughts Others can read your;
1-2-BENEFICENCE & NON-MALEFICENCE a- Think good Al Aamal O Bin Niiat Expression - Representative of your thoughts Others can read your; Face Accent Body language/Gestures You are silent, you may still be heard. Your mind can be well read.
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The Art of Communication patient doctor relationship
1-2-BENEFICENCE & NON-MALEFICENCE b-Talk / say good The Words The Art of Communication The foundation of patient doctor relationship
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1-2-BENEFICENCE & NON-MALEFICENCE
b-Talk / Say good The Words The Art of Communication [the words] Al-Quran A- Talk to the people in the most pleasant way B- Whatever you say, say good C- Don’t say anything except what is good
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1-2-BENEFICENCE & NON-MALEFICENCE C-Do good -The Acts
Education and Professional Excellence [CME] Dedication / Devotion Primarily Aim at—Patient’s wellbeing [not the material gains] “A person who practices art of healing when he is not acquainted with medicine, will be responsible for his actions.” [Hadith]
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* Patients, first and foremost * Society * Other health professionals
As a member of medical profession, we must recognize responsibility towards; * Patients, first and foremost * Society * Other health professionals * Self
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PRINCIPLES OF MEDICAL ETHICS
Conclusion Section 7 PRINCIPLES OF MEDICAL ETHICS Judicial Council American Medical Association In the practice of medicine, a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients. His fee should be commensurate with the services rendered and the patient’s ability to pay. He should neither pay, nor receive a commission for referral of patients. Drugs, remedies or appliances may be dispensed or supplied by the physician, provided it is in the best interests of the patient
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Conclusion People world over still wish to see
An Innate Desire People world over still wish to see the doctors as trustworthy and honorable.
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We Can keep this trust. Wish for others what you wish for yourself. [Hadith] How would “I” like to see a doctor If I ever become a patient myself?
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The Very Basic Of Our Code Of Conduct ?
Are we following The Very Basic Of Our Code Of Conduct ? Let Us Memorize Again I LEAVE THE QUESTION
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SIX OF THE PRINCIPLES OF MEIDCAL ETHICS
1-Beneficence Act In The Best Interest Of Humanity. 2-Non-maleficence Do No Harm 3-Autonomy Patient’s Right To Refuse Or Choose [Consent] 4-Justice Treatment On The Merit Of Illness 5-Dignity Patient And Doctor Both To Be Respected 6-Confidentiality The ’ Trust’ / Not be Shared against the will The criteria: that make the foundation of our OATH AND on the basis of which Various bodies have developed the declarations and guidelines for their regional practices That guide in making the laws governing medical practice Some Basic principles that have evolved over centuries
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Thank you Hippocrates statue, Parnassus Ave.
in front of the Robert H. Crede Ambulatory Care Center of UCSF Thank you
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References and Bibliography
PRINCIPLES OF MEDICAL ETHICS Judicial Council American Medical Association June 7, 1958 [ PDF ][online] Medical Ethics Manual. World Medical Association 3rd edition 2015[PDF][AVAILABLE ONLINE] at John R. WILLIAMS Ethics at the World Medical Association: From policy to practice JMAJ 51(4): 290–293, 2008 [ONLINE] [PDF] Sharif Kaf AL-Ghazal. Medical Ethics in Islamic history at a glance. JISHIM 2004,3 [pdf] Mustafa Y. Islam and the four principles of medical ethics. J Med Ethics Jul;40(7):479-83 Sahin Aksoy,Ali TenikThe 'four principles of bioethics' as found in 13th century Muslim scholar Mawlana's teachings BMC Medical Ethics20023:4 DOI: / Medical ethics in peacetime and wartime: the case for a better Understanding. International Review of the Red Cross (2013), 95 (889), 189–213.Violence against health care [ONLINE][PDF] doi: /S [AVAILABLE ONLINE] At: Principles for Professional Ethics. National Association of School Psychologists 2010[ PDF] [ONLINE] Codes of ethics and declarations relevant to the health Professions Fifth edition .2009 Amnesty International Ltd Peter Benenson House 1 Easton Street London WC1X 0DW United Kingdom The Cambridge textbook of bioethics, edited by P.A. Singer and A.M. Viens (Cambridge U Press, 2008) PRINCIPLES OF MEDICAL ETHICS Judicial Council American Medical Association June 7, 1958 [ PDF ][online] Section 7 In the practice of medicine a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients. His fee should be commensurate with the services rendered and the patient’s ability to pay. He should neither pay nor receive a commission for referral of patients. Drugs, remedies or appliances may be dispensed or supplied by the physician provided it is in the best interests of the patient Sharif Kaf AL-Ghazal. Medical Ethics in islamic history at aglance. JISHIM 2004,3 [pdf] [online]
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